587:
83:
344:
265:
160:
25:
410:
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804:
to deploy (in relation to the length of most incidents), emergency personnel can set up temporary interim-care centers fairly quickly if needed using the personnel and resources they have on-hand. These centers are usually staffed by a combination of doctors, nurses, paramedics/emergency medical technicians, first responders, and social workers (for example, from the
151:
casualty incident is that in a multiple casualty incident the resources available are sufficient to manage the needs of the victims. The issue of resource availability is therefore critical to the understanding of these concepts. One crosses over from a multiple to a mass casualty incident when resources are exceeded and the systems are overwhelmed.
849:, the demobilization process is not taken into account from the beginning. As a result, the process goes on much longer than necessary, which exacerbates financial costs, and puts a burden on local emergency and law enforcement services to uphold their everyday duties while also maintaining control of the mass casualty incident.
718:
to be advanced medical personnel; their role is to simply place casualties onto carrying devices and transport them to the appropriate treatment area. Casualties should be transported in order of treatment priority: red-tagged patients first, followed by yellow-tagged, then green-tagged, and finally black-tagged.
803:
setup. Permanent buildings are preferred to tents as they provide shelter, power, and running water, but many governments maintain complete field hospital setups that can be deployed anywhere within their jurisdiction within 12–24 hours. While full field hospitals require a significant amount of time
399:
Amateur Radio
Emergency Services (ARES) or Radio Amateur Civil Emergency Services (RACES) are Amateur Radio operators trained to provide emergency communications during a disaster. Often in a disaster communication systems are overloaded or completely shut down and Amateur Radio operators use special
798:
An interim-care center is a temporary treatment center which allows for the assessment and treatment of patients until they can either be discharged or transported to a hospital. These are often placed in gymnasiums, schools, arenas, community centers, hotels, and or other locations that can support
780:
may choose to have those least seriously injured transported to local hospitals or interim-care centers in order to provide more room for emergency personnel to work. It is also possible that lightly injured casualties will be transported first when access to those who are more severely injured will
717:
bearers will have to transport patients from the incident scene to safer treatment areas located nearby. These treatment areas must always be within walking distance, and will be staffed by appropriate numbers of properly certified medical personnel and support people. The litter bearers do not have
468:
and transportation agencies will be notified if an incident involves their tracks or right-of-way, or if they are required to cease operations in and through affected areas. Transportation agencies will provide buses to transport lightly injured people to the hospital. Buses can also provide shelter
699:
The cold zone: The safe zone, where any personnel who are not specially trained in HazMat and do not have chemical or biological protection gear must remain at all times. Depending on the contaminant, the cold zone should be roughly 200–300 yards from the incident, uphill and upwind. It should also
170:
A mass casualty incident will usually be declared by the first arriving unit at the scene of the incident, and less usually by an emergency call dispatcher, depending on the information that is provided by emergency units. A formal declaration of an MCI is usually made by an officer or chief of the
816:
Generally, in the healthcare field, the term "mass casualty event" (MCE) is used when hospital resources are overwhelmed by the number or severity of casualties. During these incidents, hospitals can discharge all fit patients, dedicate more resources to the emergency department, and expand their
704:
These zones should be clearly identified and with engineer tapes, lights, or cones. All responders and patients must leave the hot zone in designated pathways into the warm zone where they will be decontaminated. A designated officer should be posted at the hot zone and warm zone to make sure all
844:
method is the act of demobilization which is crucial to the entire process. The demobilization process has to be in place from the beginning, once an area has been mobilized. This is critical, as a mass casualty incident can get out of hand quickly. Having everything planned out step-by-step can
150:
in 2013 are well-publicized examples of mass casualty incidents. The most common types of MCIs are generally caused by terrorism, mass-transportation accidents, fires or natural disasters. A multiple casualty incident is one in which there are multiple casualties. The key difference from a mass
845:
alleviate these concerns and help cover for the unexpected. The demobilization process also gives the local community and the corresponding agencies an idea for how long their city and specific areas will be consumed with emergency personnel and essentially blocked off. In many events, such as
773:, transit buses, or personal vehicles. As with treatment, transport priority is determined based on the severity of the patient's injuries. Usually, the most seriously injured are transported first, with the least serious transported only after all the critical patients have been transported.
525:
will have a mass casualty incident protocol which they initiate as soon as they are notified of an MCI in their community. They will have preparations in place to receive a massive number of casualties, like calling in more staff, pulling extra and spare equipment out of storage, and clearing
476:
play an important role in keeping the general public informed about the incident and in keeping them away from the incident area. It is recommended that a Public
Information Officer be assigned as the only designated responder who communicates with the media, to prevent the spread of
817:
intensive care unit to accommodate anticipated long-term care needs. While up to 80% of victims will be transported from the scene to hospitals, others who are less injured might walk themselves to these facilities and increase the load at the closest facility to the incident.
586:
725:, flagging tape, signs, or tents. Upon arrival in the treatment area, the casualties are re-assessed and they are treated with the goal of stabilizing them until they can be transported to hospitals; transported to the morgue or medical examiner's office; or released.
737:
to await transfer of bodies to a permanent morgue, when they must be removed to access injured victims or to keep them out of public sight and prevent heightening emotions further. They are usually far aside the incident, in an existing building or pitched tent.
395:
Community
Emergency Response Teams, or CERT, are civilians trained in basic emergency response and used to assist in disasters. These teams are usually trained and maintained by Emergency Management Agencies but may also be part of Fire Departments or EMS
760:
The final stage in the pre-hospital management of a mass casualty incident is the transport of casualties to hospitals for more definitive care. If the number of ambulances available is inadequate, other vehicles may transport patients, such as
612:
is the most common and is considered the easiest to use. Using START, the medical responder assigns each patient to one of four color-coded triage levels, based on their breathing, circulation, and mental status. The triage levels are:
255:
There are multiple agencies involved in most mass casualty incidents, which means there are many individuals that require training for these specific situations. The most common types of agencies and responders are listed below.
391:
Emergency
Management Agencies may assist with procuring additional equipment and supplies for the incident. Emergency Management Incident Support Teams may assist with activities such as Planning, Logistics, Operations, and
556:
Level 3: facilities that have the ability to provide prompt assessment of a patient's injuries and respond quickly to decide whether they can perform the surgery or need to transport the individual to a level 1 or 2
359:
or rescue paramedics will perform all initial rescue-related operations, as well as fire suppression and prevention. They may also provide medical care if they are trained and assigned to do so. They may arrive on a
507:
can provide assistance with all aspects of a mass casualty incident, including trained medical staff, vehicles, individual registration and tracking, temporary shelter, food service, and many other important
560:
Level 4: facilities that are capable of performing advanced trauma life support, as well as providing a diagnostics assessment of the individual's injuries and transporting them to a higher level facility.
789:
The care that is rendered at the scene of an MCI is usually only temporary and is designed to stabilize the casualties until they can receive more definitive care at a hospital or an interim-care center.
608:. Pre-hospital emergency triage generally consists of a check for immediate life-threatening concerns, usually lasting no more than one minute per patient. In North America, the
689:
When responding to a chemical, biological, or radiological incident, the first-arriving crew must establish safety zones prior to entering the scene. Safety zones include:
546:(ACS) and passing a site review. Trauma centers have levels ranging from level 1 to level 4, with each level varying in different responsibilities and resources provided:
992:
550:
Level 1: facilities that are able to offer complete care to the patients they receive, from initial care to seeing the individual all the way through rehabilitation.
119:
with three severely injured people could be considered a mass casualty incident. The general public more commonly recognizes events such as building collapses,
572:
Ideally, once an MCI has been declared, a well-coordinated flow of events will occur, using three separate phases: triage, treatment, and transportation.
542:
play a crucial role in the mass casualty incident timeline. A hospital can receive trauma center status by meeting specific criteria established by the
309:, in their personal vehicles, or from another agency. They will have control of all aspects of patient care, as assigned by the medical officer or
175:
at the scene will be in charge of the incident, but as additional resources arrive, a senior officer or chief will take command, usually using an
553:
Level 2: facilities that are able to provide almost everything a level 1 facility offers except for tertiary care, such as complex neurosurgery.
388:
Utility services will ensure that utilities in the area are turned off as necessary, in order to prevent further injury or damage at the scene.
35:
455:
units have medical responders specifically trained in mass casualty triage who may be called in to respond to a disaster-related incident.
82:
564:
This is not an exhaustive list of agencies, and many other agencies and groups of people could be involved in a mass casualty incident.
713:
Once casualties have been triaged, they can be moved to appropriate treatment areas. Unless a patient is green-tagged and ambulatory,
1320:
1296:
1286:
1163:
1373:
770:
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are responsible for cleaning up and neutralizing any hazardous materials at the scene. Sometimes these will be specialized
414:
HazMat specialists in Level II/B protection suits training to carry a patient out of an incident zone to be decontaminated.
874:
188:
184:
1267:
1248:
1135:
926:
1110:
609:
69:
91:
369:
530:
to the scene of the incident to assist with triage, treatment, and transport of injured persons to the hospital.
636:: Patients who have non-life-threatening injuries, but are unable to walk or exhibit an altered mental status
480:
320:
will be assigned to the transport sector to transport patients and personnel to and from the incident scene,
721:
Each colored triage category will have its own treatment area. Treatment areas are often defined by colored
686:
Generally, a small group of responders, usually the first two or three crews on scene, can complete triage.
431:; or they may be privately operated teams. These teams are specialists in specific types of rescue, such as
199:
After the proper agencies have arrived, a more detailed assessment of the scene will be performed using the
1378:
596:
543:
302:
280:
1383:
372:
agreements with airport fire departments in the event of a plane crash outside of the airport boundaries.
47:
752:
284:
108:
625:: Patients who have major life-threatening injuries, but are salvageable given the resources available
276:
51:
696:
The warm zone: The area where HazMat specialists will decontaminate patients and fellow responders
868:
432:
176:
147:
116:
43:
328:. These ambulances may be municipal services, volunteer services, or from private corporations.
500:
436:
321:
139:
680:
522:
331:
287:, or may arrive on their own. They will assist with all aspects of patient care, including
143:
90:, January 21, 2011: Healthcare workers triage simulated victims during an MCI drill at the
334:
will transport patients from the scene or from designated helipads to receiving hospitals.
111:
resources, such as personnel and equipment, are overwhelmed by the number and severity of
8:
1328:
1101:
Sanders, Mick J.; McKenna, Kim D.; Lewis, Lawrence L.; Quick, Gary (December 1, 2011).
1050:
1025:
942:
777:
484:
425:
348:
310:
271:
often respond to mass casualty incidents to help transport the large amount of patients
1282:
1263:
1244:
1159:
1131:
1106:
1055:
922:
846:
112:
705:
contaminated personal are treated and decontaminated before entering the cold zone.
385:
will secure and control access to the scene, to ensure safety and smooth operations.
1304:
1210:
1045:
1037:
967:
829:
343:
886:
880:
421:
138:
and other large-scale emergencies as mass casualty incidents. Events such as the
1327:. United States Department of Homeland Security. 6 November 2016. Archived from
916:
647:: Patients who are able to ambulate out of the incident area to a treatment area
264:
825:
800:
504:
488:
452:
382:
179:
structure to form a unified command to run all aspects of the incident. In the
449:(chemical, biological, radiological, nuclear and high-yield explosives) teams.
1367:
1344:
1073:
599:
Greg Tetro breaks the rear glass of an automobile to rescue a trapped victim.
539:
268:
180:
131:
892:
496:
87:
1059:
658:: Used for victims who are dead, or whose injuries make survival unlikely.
159:
776:
In an effort to remove as many lightly injured civilians as possible, an
592:
442:
356:
135:
1180:
1041:
409:
1243:(8th ed.). Philadelphia, PA: Elsevier/Saunders. pp. Chapter.
762:
746:
673:
669:
473:
428:
361:
306:
127:
115:. For example, an incident where a two-person crew is responding to a
1010:
821:
805:
766:
722:
714:
527:
492:
317:
298:
172:
1181:"Hospital Preparedness for Emergency Response: United States, 2008"
948:(Report). United States Department of Homeland Security. p. 13
862:
518:
465:
292:
16:
Incident which results in medical care systems becoming overwhelmed
662:
Triage personnel do not conduct treatment, with the exception of:
526:
non-acute patients out of the hospital. Some hospitals will send
365:
325:
164:
291:
and treatment at the scene, and transport from the scene to the
191:, "NIMS provides the template for the management of incidents."
1303:. DelValle Institute for Emergency Preparedness. Archived from
858:
841:
734:
605:
581:
288:
351:
to provide light to allow emergency responders to see properly
917:
Mistovich, Joseph J.; Karren, Keith J.; Hafen, Brent (2013).
840:
The final product of an MCI that happens to link up with the
446:
120:
679:
Where allowed by local protocols, needle decompressions for
1241:
Rosen's
Emergency Medicine: Concepts and clinical practice
993:"Community Emergency Response Team (CERT) | FEMA.gov"
700:
be at least 50 yards uphill and upwind from the warm zone.
203:, which summarizes information necessary for responders:
124:
1100:
469:
at the scene (for example, "warming buses") if required.
424:; they may be associated with the state, provincial, or
808:), who work to get families reunited after a disaster.
865:
for the information to include when declaring an MCI)
781:
be delayed due to heavy or difficult rescue efforts.
1279:
Current
Therapy of Trauma and Surgical Critical Care
1156:
Current
Therapy of Trauma and Surgical Critical Care
1130:(7th ed.). McGraw-Hill Education. p. 123.
400:
frequencies to assist with disaster communications.
1178:
420:Specialized rescue teams may be part of the local
1158:(1st ed.). Philadelphia: Mosby. p. 68.
591:In an MCI drill aboard Naval Air Station Oceana,
1365:
610:START system (simple triage and rapid treatment)
733:Some mass casualty incidents require an onsite
183:, the Incident Command System is known as the
259:
163:Police arrive at a mass casualty incident in
32:The examples and perspective in this article
347:At night, firefighters will often utilize a
250:
1049:
1023:
70:Learn how and when to remove this message
745:
585:
408:
364:or from another agency. Many areas near
342:
263:
171:agency in charge. Initially, the senior
158:
81:
1276:
1262:(7th ed.). McGraw-Hill Education.
1153:
1096:
1094:
1366:
1257:
1125:
811:
793:
1297:"Activating A Mass Casualty Response"
1281:(1st ed.). Philadelphia: Mosby.
1149:
1147:
968:"Activating A Mass Casualty Response"
604:The first-arriving crew will conduct
1238:
1091:
912:
910:
908:
404:
18:
1321:"Incident Command System Resources"
1105:. Jones & Bartlett Publishers.
943:National Incident Management System
935:
875:National Incident Management System
693:The hot zone: The contaminated area
194:
189:Federal Emergency Management Agency
185:National Incident Management System
13:
1185:National Health Statistics Reports
1144:
784:
459:
338:
14:
1395:
1301:DelValle Institute Knowledge Base
1215:DelValle Institute Knowledge Base
972:DelValle Institute Knowledge Base
905:
835:
534:
240:Number of casualties and severity
107:) describes an incident in which
1345:"Trauma Center Levels Explained"
1074:"Trauma Center Levels Explained"
728:
376:
92:Center for Domestic Preparedness
23:
1232:
1203:
1172:
324:of hospitals, and a designated
1119:
1066:
1017:
1003:
985:
960:
481:Non-governmental organizations
305:(EMT) personnel may arrive in
154:
1:
1179:Niska RW; Shimizu IM (2011).
1026:"Towards optimal trauma care"
898:
741:
708:
544:American College of Surgeons
512:
303:emergency medical technician
283:may arrive as part of local
281:emergency medical responders
7:
1374:Critical emergency medicine
1239:Marx, John A. Marx (2014).
852:
655: Deceased or expectant
246:Emergency services required
46:, discuss the issue on the
10:
1400:
1103:Mosby's Paramedic Textbook
919:Prehospital Emergency Care
579:
285:emergency medical services
277:Certified first responders
260:Emergency medical services
109:emergency medical services
1351:. American Trauma Society
575:
187:(NIMS). According to the
1277:Trunkey, Donald (2008).
1258:Mattox, Kenneth (2013).
1154:Trunkey, Donald (2008).
1126:Mattox, Kenneth (2013).
824:, chemical emergencies,
751:Ambulance on scene with
1078:American Trauma Society
869:Incident Command System
644: "Walking wounded"
567:
433:urban search and rescue
251:Agencies and responders
177:incident command system
148:Boston Marathon bombing
117:motor vehicle collision
1349:America Trauma Society
889:(an MCI drill in 2000)
757:
681:tension pneumothoraces
601:
416:
352:
272:
210:Mass incident declared
167:
101:mass casualty incident
96:
749:
672:for life-threatening
589:
523:emergency departments
501:Medical Reserve Corps
437:confined space rescue
412:
346:
322:emergency departments
267:
162:
140:Oklahoma City bombing
85:
1211:"MCI Demobilization"
368:will have automatic
201:M.E.T.H.A.N.E method
144:September 11 attacks
103:(often shortened to
52:create a new article
44:improve this article
34:may not represent a
1379:Incident management
1307:on 1 September 2017
1042:10.1136/emj.2.4.181
812:Mass casualty event
794:Interim-care center
1384:Emergency medicine
1024:Trunkey D (1985).
999:. August 29, 2022.
778:incident commander
758:
602:
485:St. John Ambulance
417:
353:
349:Light and air unit
311:incident commander
273:
168:
97:
1288:978-0-323-04418-9
1165:978-0-323-04418-9
921:. Prentice Hall.
883:(French MCI plan)
847:Hurricane Katrina
830:natural disasters
820:MCEs can include
666:Airway maneuvers;
405:Specialized teams
234:Access and egress
146:in 2001, and the
80:
79:
72:
54:, as appropriate.
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1331:on 30 April 2017
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1011:"Ares Races Faq"
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222:Type of incident
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881:Orsec-Novi plan
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785:Definitive care
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622: Immediate
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477:misinformation.
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339:Fire and rescue
269:Ambulance buses
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1030:Arch Emerg Med
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928:978-0133369137
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842:M.E.T.H.A.N.E.
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836:Demobilization
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832:like weather.
826:mass shootings
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801:field hospital
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38:of the subject
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1036:(4): 181–95.
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763:police cars
670:Tourniquets
593:firefighter
429:governments
155:Declaration
136:earthquakes
1368:Categories
952:January 3,
899:References
767:firetrucks
723:tarpaulins
674:hemorrhage
503:, and the
435:(USAR) or
370:mutual aid
362:fire truck
318:ambulances
307:ambulances
128:collisions
113:casualties
822:epidemics
806:Red Cross
742:Transport
709:Treatment
557:facility.
519:Hospitals
513:Hospitals
508:services.
493:Red Cross
396:Agencies.
392:Recovery.
299:Paramedic
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863:mnemonic
853:See also
483:such as
466:Railways
366:airports
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528:doctors
426:federal
326:helipad
316:Ground
165:Toronto
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1313:2017
1283:ISBN
1264:ISBN
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1197:2016
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1056:PMID
979:2017
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568:Flow
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